Pyonephrosis complicated by nephropleural and nephrocutaneous fistula
Presentation
Right renal mass and anemia. Known HIV positive - defaulter.
Patient Data
Enlarged and deformed right kidney with fluid and air loculi in the grossly distended calyces and pelvis with significant perinephric fluid collection and fat stranding. Multiple non-obstructive calculi within the dilated calyces and pelvis, and multiple obstructive ureteric calculi. Enhancing fistulous tracts at the level of L2, connecting the right retroperitoneal collection to the subcutaneous tissue through the right paravertebral soft tissue. Similar fistulous tracts also connect the collection to the right posterior pleura through the posterior hemidiaphragm. No bone involvement.
The constellation of findings is indicative of right pyonephrosis complicated by nephropleural and nephrocutaneous fistulas.
Case Discussion
Multiple obstructive ureteric calculi in the background of pyelonephritis is most likely the culprit for pyonephrosis. The pressure from pyonephrosis was released to the perinephric space and through the fistulous tracts to the pleura and subcutaneous tissue.
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